HX641 27753 
RC161  .C85  An  essay  on  the  indi    , 


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INDIGENOUS 


Malarial  Diseases, 


WYOMING  VALLEY. 


AN  ESSAY 


Indigenous  Malarial  Diseases 


OF    WYOMIMG  VALLEY, 


READ,  BY  APPOINTMENT,  BEFORE 


THE  LUZERNE  COUNTY  MEDICAL  SOCIETY, 


Dr.  JOHN  B.  CRAWFORD, 


WILKES-BARRE,   PA.,  MAY  11,  1881. 


jJnblisbtb  bo  rtquest  of  %  Socictu. 


WILKES-BARRE,  PA. 
1881. 


The  Indigenous  Diseases  of  Wyoming  Valley. 


The  duty  was  assigned  me,  at  the  last  meeting  of  our 
Society,  of  opening  a  discussion  to-day  upon  the  subject  of 
our  "  Endemic  Malarial  Diseases."  The  time  which  has 
intervened  between  the  last  meeting  and  this  has  not  only 
been  brief,  but  it  has  been  a  period  of  unusual  labor  in  my 
ordinary  professional  duties,  and  I  have  therefore  had  but 
little  opportunity  for  investigating  the  subject  of  this  dis- 
cussion. 

The  paper  which  I  have  now  to  present  is  but  little  more 
than  some  rough  notes  which  I  have  jotted  down  at  brief 
intervals,  and  amid  frequent  interruptions.  I  regret  that 
I  have  not  been  able  to  give  this  subject  the  careful  study, 
and  the  close,  consecutive  thought  that  a  matter  of  so  much 
interest  and  importance  demands.  I  trust,  however,  that 
my  own  deficiencies  will  be  more  than  compensated  for  by 
the  other  members  who  are  expected  to  take  part  in  this 
discussion. 

The  air,  which  was  designed  for  the  respiration  of  the 
higher  forms  of  animated  beings,  contains  in  its  pure  state  : 

Specific  gravity,  1 ,000. 

A  trace  of  carbonic  acid  and  a  varying  amount  of  vapor 
are  always  found  diffused  through  .the  atmosphere,  but  are 
not  supposed  to  vitiate  it  in  any  degree,  or  to  render  it  less 
adapted  to  the  purposes  of  respiration,  or  to  the  maintenance 
of  health.  "  Bad  air,"  therefore,  or  "malaria,"  designates,  in 
its  broadest  sense,  some  adulteration  or  changed  condition 
of  the  atmosphere,  or  some  admixture  of  noxious  materials 
therewith,  rendering  it  unsuited  to  the  respiratory  require- 
ments of  the  animal  system  ;  or  of  exciting  therein  those 
aberrations  of  vital  function  which  we  call  disease. 


Weight. 

Volume. 

Oxygen,  ■ 

"    "     23,    ■ 

-    -    21. 

Nitrogen, 

-  77,  ■ 

■  -  79-.. 

As  this  term,  "  malaria,"  is  generally  used  by  the  medical 
profession,  and  as  it  is  usually  understood,  it  designates  an 
atmosphere  vitiated  by  the  emanations  of  low,  swampy  or 
marshy  grounds,  produced  either  by  the  effluvia  of  decom- 
posing vegetation,  the  gaseous  exhalations  of  a  marshy  soil, 
or  by  the  minute  spores  of  cryptogamic  plants  ;  and  the 
effects  of  which  are  seen  in  the  various  forms  of  intermitting, 
remitting  and  continued  fevers. 

On  a  former  occasion  I  stated  to  this  society  my  reasons 
for  believing  that  this  form  of  malaria  is  produced  by  the 
spores  of  fungiferous  vegetation.  I  need  not,  therefore, 
now  enter  into  a  discussion  of  the  subject  of  malarial 
poisons,  or  the  sources  of  malarial  diseases  in  the  sense  that 
these  subjects  are  generally  understood  throughout  the 
world,  and  by  the  medical  profession. 

The  terms  in  which  my  allotted  task  for  to-day  is  ex- 
pressed, "  Indigenous  Malarial  Disease,"  would  seem  to 
imply  the  idea  that  there  is  in  the  atmosphere  of  our  locality 
some  peculiar  quality,  or  material,  differing  in  its  nature, 
and  varying  in  its  effects,  from  the  marsh-tainted  atmos- 
phere of  other  malarial  districts ;  that  we  have  around  and 
among  us  a  class  of  diseases  deriving  their  origin  from  a 
vitiated  atmosphere,  yet  differing  in  respect  to  the  symp- 
toms which  they  present,  or  to  the  poisons  that  produce 
them,  or  in  both,  from  the  malarial  diseases  of  other  lo- 
calities. 

It  will  be  well,  therefore,  at  the  outset  of  this  discussion, 
to  carefully  survey  the  locality  in  which  these  peculiarities 
may  be  supposed  to  exist ;  to  take  a  bird's-eye  view  of  its 
conformation  and  surroundings ;  to  observe  whatever  may 
serve  to  exert  a  deleterious  effect  upon  the  health  of  its 
inhabitants;  and  to  study  those  impalpable,  yet  potent  mor- 
bific agents  that  may  be  engendered  by  the  peculiar  con- 
ditions that  surround  us.  The  city  of  Wilkes-Barre  and 
its  neighboring  towns  are  situated  in  a  valley,  or  rather 
basin,  closely  surrounded  by  hills,  which  vary  in  height 
from  eight  hundred  to  one  thousand  feet.     The  bottom   of 


this  basin  is,  in  the  main,  level ;  the  soil  alluvial,  in  some 
parts  consisting  of  a  coarse  gravel,  but  mainly  formed  of  a 
sandy  loam.  A  few  marshes  of  small  extent  are  found 
within  its  borders,  and  a  limited  portion  of  its  surface  con- 
sists of  a  clayey  loam.  A  river  of  considerable  size,  with  a 
moderate  but  not  sluggish  current  passes  through  its  longest 
diameter.  Abundant  springs  of  pure  water  flow  (or  rather 
once  did  flow)  to  the  surface  in  every  portion  of  the  valley. 
Numerous  streams  glide  down  the  mountain  ravines,  and 
empty  their  currents  into  the  Susquehanna.  Such  is,  or 
rather  was,  the  topographical  character  of  Wyoming  Valley. 
Beneath  its  surface  and  extending  far  up  on  its  contiguous 
mountain  sides  are  rich  deposits  of  anthracite  coal.  The 
processes  of  mining  and  utilizing  this  coal,  and  the  indus- 
tries which  have  been  developed  in  connection  therewith, 
have  wrought  extensive  and  important  changes,  not  only 
in  respect  to  population,  to  water  supply,  and  to  drainage, 
but  have  changed  the  constituent  elements  of  our  atmos- 
phere in  many  and  important  respects. 

I  am  informed  that  previous  to  the  construction  of  the 
North  Branch  Canal  and  the  building  of  a  dam  across  the 
Susquehanna  River  at  Nanticoke,  ague  and  remitting  fevers 
and  the  other  forms  of  miasmatic  diseases  were  unknown  in 
this  valley  ;  but  that  their  occurrence  immediately  followed 
the  construction  of  these  works.  For  several  years  sub- 
sequently each  summer  and  autumn  brought  an  annual 
epidemic  of  chills  and  fever ;  and  this  yearly  recurrence  of 
miasmatic  disease  has  been  seen  in  the  vicinity  of  Nanticoke 
up  to  the  present  time.  But,  as  is  usually  the  case,  the 
succeeding  cold  weather  of  autumn  and  winter  checked  or 
destroyed  the  epidemic  influence,  and  a  period  of  compara- 
tive healthfulness  ensued.  The  miasm  which  produces  this 
endemic  disease  seems  to  be  engendered  by  the  successive 
flooding  and  drying  of  a  considerable  portion  of  the  soil 
situated  contiguous  to  the  village  of  Nanticoke,  caused  by 
the  dam  which  I  have  mentioned. 

But  there  are  other  and  more  important   particulars   in 


which  the  salubrity  of  our  atmosphere  or  our  locality  have 
been  interfered  with.  In  order  to  properly  estimate  these 
it  will  be  necessary  to  consider  somewhat  in  detail  the 
sources,  the  amount,  the  composition,  and  the  effects  of  the 
various  gaseous  products  of  anthracite  coal,  as  well  as  of 
the  various  other  contaminating  agencies  affecting  not  only 
the  air  which  we  breathe,  but  likewise  the  water  which  we 
drink. 

Issuing  from  various  portions  of  the  surface  of  our  valley 
are  streams  of  carbureted  hydrogen.  This  is  evolved  in 
immense  quantities  in  every  portion  of  the  coal  fields,  and 
is  generated  in  some  of  our  coal  mines  in  quantities  so  great 
as  to  be  past  computation.  I  am  informed  by  the  Superin- 
tendent of  one  of  the  coal  mines  within  our  city  limits,  that 
the  quantity  of  this  gas  which  is  being  constantly  evolved 
within  that  mine  is  so  great  that,  if  the  appliances  for  its 
removal  were  arrested  for  the  short  space  of  fifteen  minutes, 
the  life  of  every  person  within  the  mine  would  thereby  be 
endangered.     This  gas  consists  of: 

Atotns.  Weight.  Volume. 

Hydrogen,  -  -  2,  -  -  -  24.6,  -  -  -  2,  1  , 

r    1  >sp.  gr.   ;o2. 

Carbon,     -  -  -   I, 75.4,  -  -  -   1,  J    r  &      D 

This  gas  is  most  dangerous  in  consequence  of  its  ex- 
plosive qualities,  and  is  popularly  known  as  fire  damp.  It 
is,  of  course,  unsuited  to  the  purposes  of  respiration,  but  is 
not  directly  poisonous  in  its  effects.  The  worst  conse- 
quences of  its  inhalation  probably  result  from  the  adulte- 
rated, or  rather  the  diluted,  condition  of  the  atmosphere 
produced  by  its  presence.  As  its  specific  gravity  is  much 
less  than  that  of  air,  it  becomes  speedily  dissipated.  It  is 
not  probable  that  this  substance  seriously  vitiates  the  atmos- 
phere, except  in  the  way  of  rendering  it  less  invigorating, 
and  thus  lowering  the  force  of  the  vital  powers. 

Within  the  boundaries  of  Wyoming  Valley  there  is  annu- 
ally mined  about  eight  million  tons  of  coal.  About  twenty- 
five  per  cent,  of  this  amount,  or  two  million  tons,  is  consumed 
as  wastage,  and  is  piled  up  in  numerous  places  about  the 


mines.  These  culm-heaps,  as  they  are  called,  have  accu- 
mulated for  many  years,  and  it  would  be  difficult  to  estimate 
the  amount  of  this  material  which  exists  in  almost  every 
portion  of  the  valley.  These  great  mounds,  (they  sometimes 
amount  almost  to  mountains,)  are  now  nearly  all  on  fire  ; 
and  the  amount  of  coal  thus  undergoing  combustion  is  at 
least  equal  to  the  annual  accumulation  of  refuse,  or  about 
two  million  tons.  In  addition  to  this  it  is  estimated  that 
about  three  hundred  and  seventy-five  thousand  tons  are  an- 
nually consumed  for  domestic,  manufacturing  and  other 
purposes  within  the  valley.  Besides  these  we  should  take 
into  account  the  vast  amount  of  coal  undergoing  combustion 
within  the  mines.  I  have  no  means  of  estimating  accurately 
the  amount  of  coal  that  is  thus  consumed,  but  it  has,  pro- 
bably for  several  years,  amounted  to  considerably  more  than 
half  a  million  tons  annually.  Thus  we  see  that  about 
three  million  tons  of  anthracite  coal  are  being  yearly  con- 
sumed within  the  area  which  we  are  considering ;  and  that 
nearly  all  of  it  is  undergoing  a  slow  and  imperfect  combus- 
tion. This  amounts  to  about  eight  thousand  and  two 
hundred  tons  of  coal  daily  consumed  in  this  manner,  and 
of  course  diffusing  its  noxious  products  through  the  at- 
mosphere. 

Besides  carbureted  hydrogen,  the  gases  evolved  by  the 
combustion  of  anthracite  coal  are,  carbonic  acid,  sulphureted 
hydrogen,  sulphurous  acid,  and  carbonic  oxide. 

Carbonic  acid  is  composed  of: 

Atoms.  Weight.  Volume. 

Oxygen,     --  2,  ---  72.73,  --  -   ^\  s 

Carbon, 1, 27.27, i,/^s        D 

This  gas,  although  containing  a  larger  proportion  of 
oxygen  than  atmospheric  air,  is  still  unsuited  to  the  purposes 
of  respiration.  The  oxygen  which  it  contains,  being  chemi- 
cally combined  by  complete  combustion,  is  therefore  in- 
capable of  entering  into  new  combinations  in  the  capillaries 
of  the  lungs,  and  of  decarbonizing  the  blood.  It  does  not 
seem  to  be  directly  poisonous,  although  animals  die  when 


placed  in  it  about  as  quickly  as  if  placed  under  water,  and 
in  a  very  similar  manner.  There  is  this  difference,  however: 
an  animal  placed  under  water  for  a  short  time  may  be 
resuscitated  after  being  removed  from  that  fluid,  but  an 
animal  being  placed  in  carbonic  acid,  and  having  once  in- 
haled that  substance,  is  usually  incapable  of  resuscitation. 
The  reason  probably  is,  that  the  specific  gravity  of  carbonic 
acid  being  much  greater  than  that  of  atmospheric  air,  it  is 
consequently  retained  in  the  air-cells  of  the  lungs;  thus 
effectually  preventing  the  ingress  of  air,  and  causing  death 
by  asphyxia.  Even  when  largely  diluted  it  is  still  capable 
of  producing  most  noxious  effects. 

I  have  already  stated  that  a  small  proportion  of  carbonic 
acid  is  everywhere  found  mingled  with  the  atmosphere. 
This  proportion  is  usually  from  three-tenths  to  four-tenths 
of  one  per  cent.  Whenever  the  proportion  rises  much 
above  this  the  atmosphere  becomes  unwholesome.  When 
it  reaches  even  three  per  cent,  it  is  wholly  unfit  for  respira- 
tion. When  it  reaches  five  per  cent,  it  is  highly  dangerous 
to  life  to  breathe  it  even  for  a  short  time  ;  and  when  its  pro- 
portion is  increased  to  eight  or  ten  per  cent,  it  becomes 
suddenly  and  certainly  fatal. 

The  high  specific  gravity  of  this  gas  prevents  its  rapid 
dissipation,  and  renders  it  capable  of  being  forced  in  a  con- 
centrated state,  by  air  currents,  in  any  direction,  and  to 
considerable  distances.  It  must,  therefore,  become  pretty 
generally  diffused,  in  varying  proportions,  throughout  our 
atmosphere.  The  effects  produced  by  this  gas  in  a  pure, 
or  in  a  concentrated,  state  are  well  understood;  but  the 
effects  produced  by  it  in  its  more  diluted  forms  are  proba- 
bly not  so  well  ascertained.  It  seems  to  exert  its  deleterious 
effects  by  preventing  the  due  oxydation  of  the  blood,  and 
thus  manifesting  its  morbific  power  in  disturbances  of  the 
nervous  system.  Headache,  vertigo,  fainting,  nausea,  pains 
in  the  loins,  lethargy,  palpitation,  &c,  are  generally  men- 
tioned as  characteristic  effects  of  its  inhalation.  The  severity 
of  these  symptoms  must,  of  course,  depend  upon  the  quanti- 


9 

ty  inhaled,  as  well  as  upon  the  nervous  susceptibility  of  the 
person  afflicted.  I  have  no  means  of  estimating  the  amount 
or  the  proportion  of  this  gas  which  is  present  in  the  air  of 
this  valley.  It  doubtless  varies  greatly  with  other  varying 
conditions  of  the  atmosphere.  Its  general  tendency  is  to 
accumulate  near  the  surface,  and  in  the  lowest  spaces.  But 
this  tendency  may  be  overcome  by  wind  currents,  by  heat, 
and  by  the  tendency  which  all  gasses  have  of  mixing  to- 
gether, or  of  diffusibility ;  and  it  may  in  this  way  become 
mingled  with  the  atmosphere  in  more  elevated  locations. 
The  amount  of  coal  undergoing  combustion  about  us  is 
such  as  to  indicate  that  an  immense  quantity  of  this  gas  is 
being  constantly  mixed  with  the  atmosphere  that  we  are 
required  to  breathe  ;  such  an  amount,  indeed,  as  must  seri- 
ously interfere  with  the  health  and  vigor  of  those  who 
constantly  respire  it. 

Another  of  the  gases  evolved  by  the  combustion  of  an- 
thracite coal,  and  the  effects  of  which  we  have  to  consider, 
is  sulphureted  hydrogen.     This  is  composed  of: 

sp.  gr.  1. 174. 

This  is  an  exceedingly  active  poison.  Thenard  states 
that  atmospheric  air  which  contains  one-fifteen-hundredth 
part  of  its  volume  of  this  gas  will  destroy  a  bird  ;  one-eight- 
hundredth  part  of  it  will  destroy  a  dog,  and  one-two- 
hundredth-and-fiftieth  part  of  it  will  kill  a  horse.  Taylor, 
in  his  "Medical  Jurisprudence,"  says,  "Sulphureted  hydro- 
gen gas,  when  breathed  in  its  pure  state,  is  instantaneously 
fatal.  It  exerts  equally  deleterious  effects  upon  all  orders 
of  animals  and  upon  the  textures  of  the  body.  It  has  been 
known  to  destroy  life  even  when  allowed  to  remain  in  con- 
tact with  the  skin."  As  this  gas  is  generated  by  the  com- 
bustion of  coal,  it  is  usually  accompanied  and  mixed  with 
sulphurous  acid  gas  [S.  O.  2].  The  effects  of  each  of  these 
gases  are  very  similar,  both  in  respect  to  the  symptoms 
which  they  present  in  the  living,  and  in  the  lesions  found, 


Atoms. 

Weight. 

Volume. 

Sulphur,  -  - 

-     I,   -    - 

-    -    94.I5,    ■ 

-  -   1-6, 

Hydrogen,  - 

-     I,   -    ■ 

■     -        5-85,- 

-     1, 

IO 

as  a  result  of  their  inhalation,  on  post  mortem  examination. 
The  effects  produced  by  these  gases  in  a  pure  state,  as  well 
as  in  a  state  of  moderate  dilution,  are  also  well  understood. 
Works  on  medical  jurisprudence  abound  in  instances  of  death 
produced  by  them  in  a  concentrated  state,  as  well  as  of  the 
post  mortem  appearances  presented  by  their  victims.  In 
cases  of  fatal  inhalation  of  these  gases,  the  symptoms 
usually  noticed  are  purple  lips,  lividity  of  countenance, 
surface  of  body  cold,  hands  and  nails  purple,  inspiration 
quick  and  short,  pulse  small,  quick  and  feeble,  pupils  fixed, 
and  total  insensibility.  The  post  mortem  appearances  usually 
observed,  are  congestion  of  membranes  of  brain,  effusion  of 
fluid  under  the  arachnoid,  sinuses  gorged  with  blood, 
lungs  congested,  and  right  cavities  of  heart  engorged.  The 
consequences  resulting  from  the  inhalation  of  these  gases, 
in  their  more  dilute  form,  must  vary  in  their  intensity,  as 
well  as  in  the  character  of  the  symptoms  produced,  accord- 
ing to  the  amount  inhaled,  the  proportion  of  the  noxious 
materials,  as  compared  with  the  respired  air,  the  vigor  and 
susceptibility  of  the  person  affected.  The  results  in  these 
cases  of  slow,  constant  and  partial  poisoning  have  not  been 
studied  with  the  care  and  precision  which  their  importance 
demands,  and  I  apprehend  that  their  damaging  effects  upon 
public  health  are  not  adequately  understood  and  appreciated 
even  by  the  medical  profession.  As  an  illustration  of  the 
powerful  effects  of  these  gases  upon  the  lower  forms  of  life, 
I  may  mention  that,  during  a  period  of  thirty  years  which  I 
have  practiced  medicine  in  this  valley,  I  have  never  once 
seen  a  case  of  psora,  or  itch,  which  originated  within  our 
anthracite  coal  field;  nor  have  I  seen  one  which,  having 
been  brought  here,  did  not  speedily  recover,  without  medi- 
cal treatment.  This  disease,  as  is  well  known,  is  produced 
by  a  minute  insect,  which  burrows  in  the  skin.  Sulphur- 
ous gases  have  long  been  known  as  an  efficient  remedy  for 
this  disease.  It  is  evident  that  our  atmosphere  contains  a 
sufficient  amount  of  these  gases  to  effectually  destroy  this 
insect.     This  is  one  of  the  compensations  which  we  enjoy 


1 1 

for  being  compelled  to  respire  an  unwholesome  atmosphere; 
but  it  forcibly  illustrates  the  important  changes  that  may 
be  wrought  within  our  bodies  by  agents  whose  presence,  or 
even  whose  existence,  is  unsuspected. 

Another  contaminating  ingredient  of  our  atmosphere, 
which  is  engendered  by  the  combustion  of  coal,  is  carbonic 
oxide.      It  is  composed  of: 

Atoms.  Weight.  Volume. 

Oxygen,  -  -    I,  -  -   s6.6g,  -  -    1-2,    ) 

Carbon,    -  -    1,  -  -  43.31,  -   -       I,    J    ^    s      <  ' D 

We  have  already  seen  that  carbonic  acid  consists  of  one 
atom  of  oxygen  and  two  of  carbon.  Carbonic  oxide  con- 
tains one  atom  of  oxygen  and  one  of  carbon.  In  its  forma- 
tion, therefore,  but  one-half  as  much  oxygen  is  abstracted 
from  the  atmosphere  as  in  the  former,  but  its  effect  in 
vitiating  the  air  is  far  greater  than  that  of  carbonic  acid. 
Carbonic  acid,  as  we  have  seen,  exercises  its  deadly  power 
by  choking  or  obstructing  the  air  cells  of  the  lungs,  and 
preventing  the  ingress  of  oxygen.  Carbonic  oxide  is  a 
deadly  and  rapid  narcotic  poison.  An  atmosphere  contain- 
ing only  one  per  cent,  of  this  gas  will  destroy  life  in  a  few 
minutes,  and  in  its  pure  state  it  is  almost  instantaneously 
fatal.  It  passes  rapidly  into  the  blood.  In  an  animal  which 
inhaled  air  containing  ten  per  cent,  of  this  substance  for 
thirty  seconds,  the  blood  was  found  to  contain  four  per 
cent,  of  carbonic  oxide,  and  a  diminished  proportion  of 
oxygen.  The  blood  is  brightened  in  color  by  its  inhalation, 
as  it  is  darkened  by  the  effects  of  carbonic  acid.  This 
bright  color  is  very  permanent.  It  has  been  observed  to 
continue  for  three  weeks  in  animals  which  had  been  sub- 
jected to  its  influence.  Its  mode  of  action  is  supposed  to 
be  the  reverse  of  that  of  carbonic  acid — that  is,  it  produces 
its  poisonous  effects  by  preventing  the  arterial  blood  from 
becoming  venous,  while  carbonic  acid  poisons  by  prevent- 
ing the  venous  blood  from  becoming  arterial.  In  animals 
that  have  died  from  the  effects  of  this  gas  in  a  diluted  state, 
there  has  been  observed  an  engorgement  of  the  muscles  of 


12 

the  heart,  a  congested  state  of  the  brain,  and  an  anaemic 
condition  of  the  spleen.  But  when  life  has  been  destroyed 
by  the  inhalation  of  this  substance  in  a  pure  state,  death  has 
ensued  so  rapidly  that  very  few  post  mortem  appearances 
were  produced.  This  gas  is  generated,  like  carbonic  acid, 
by  the  combustion  of  coal,  or  the  oxydation  of  carbon.  It, 
however,  is  the  product  of  an  incomplete  combustion,  and 
the  oxygen  concerned  in  its  production  is  only  half  as  great, 
in  proportion  to  the  carbon  entering  into  the  combination, 
as  in  the  case  of  carbonic  acid.  The  slow  combustion  con- 
stantly going  on  in  the  culm  heaps  would  seem  to  be  espec- 
ially favorable  to  the  formation  of  this  gas.  This  combus- 
tion goes  on,  for  the  greatest  part,  with  but  a  very  limited 
amount  of  oxygen;  and  much  of  it  takes  place  under  cir- 
cumstances which  admit  of  only  the  smallest  supply  of 
oxygen  that  renders  combustion  possible.  Wherever  the 
air  has  free  access  to  the  burning  materials,  carbonic  acid, 
as  well  as  sulphurous  acid  and  carbureted  hydrogen,  are 
produced;  but  in  a  slow  and  imperfect  combustion,  where 
the  temperature  becomes  high,  and  where  atmospheric  air 
finds  limited  access,  as  in  the  interior  of  a  burning  culm 
pile,  carbonic  oxide  and  sulphureted  hydrogen  are  evolved 
in  the  greatest  abundance.  Thus  it  will  be  seen  that  the 
combustion,  which  is  so  extensively  going  on  in  the  culm 
heaps  all  around  us,  furnishes  just  the  conditions  which  are 
most  favorable  for  the  evolution  of  the  greatest  quantity  of 
noxious  gases,  as  well  as  of  gases  of  the  most  noxious  kinds, 
that  the  combustion  of  coal  is  capable  of  producing. 

In  addition  to  the  contaminating  agencies  contained  in  our 
atmosphere  that- 1  have  already  described,  there  are  other 
products  of  decomposing  materials  about  the  air  of  our  city 
which  should  not  be  overlooked  when  investigating  the 
sources  of  our  epidemic  diseases.  We  have,  within  a 
limited  area,  a  population  of  considerably  more  than 
twenty  thousand.  We  have  a  flat  and  even  surface,  with 
little  natural  drainage,  and  that  little,  for  the  most  part, 
artificially  obstructed.      We  have  had,  until  very   recently, 


an  almost  entire  absence  of  sewerage,  and  we  still  have 
only  a  very  limited  extent  of  it.  The  few  sewers  which 
have  thus  far  been  constructed  discharge  their  contents 
on  the  margin  of  the  river,  in  close  proximity  to  the 
most  populous  portion  of  the  town,  leaving  their  decompos- 
ing materials  to  generate  foetid  and  noxious  gases  along 
the  entire  river  front  of  the  city — polluting  alike  earth,  air 
and  water  along  its  whole  extent.  But  by  far  the  larger 
portion  of  our  city  has  not,  and  never  has  had,  any  sewer- 
age whatever.  Contained  within  the  soil,  in  old  wells,  and 
in  cess-pools,  and  in  some  places  festering  upon  the  surface, 
is  the  accumulated  filth  and  nastiness  of  a  century — a 
century  of  neglect,  indifference  to,  and  defiance  of  natural 
sanitary  laws.  Far  less  neglect  of  sanitary  measures  than 
is  here  seen  has  spread  death  and  desolation  through  many 
a  town  and  city.  In  view  of  the  persistent  and  reckless  neg- 
lect on  the  part  of  our  inhabitants,  or  our  authorities,  to  pro- 
vide for  the  protection  of  their  health  or  the  prevention  of 
disease,  it  seems  the  imperative  ditty  of  the  medical  profes- 
sion to  urge  and  to  insist  upon  the  adoption  and  the  speedy 
execution  of  some  efficient  measures  for  the  purification  of 
our  city.  In  the  light  of  the  history  and  experience  of  other 
cities,  it  seems  strange  that  the  people  of  Wilkes-Barre  have 
hitherto  escaped  the  penalties.and  the  pestilence  which  per- 
sistent neglect  of  sanitary  laws  must  sooner  or  later  engen- 
der. It  is  criminal  folly  to  attempt  to  ignore  the  fact  that 
the  atmosphere  we  are  breathing  is  largely  made  up  of 
materials  that  are  highly  injurious  to  health,  that  were  never 
designed  for  respiration,  and  that  the  great  quantities  of 
carbonic  and  sulphurous  gases  that  are  constantly  being 
mixed  with  the  air  around  us,  which  proper  prudence  can 
greatly  diminish,  together  with  the  exhalations  of  the 
immense  amount  of  decomposing  matter,  which  can  be,  and 
long  ago  should  have  been,  removed  and  rendered  innocu- 
ous, must  necessarily  produce,  and  does  produce,  an  atmos- 
phere better  suited  to  the  respiratory  requirements  of  the 


14 

extinct  saurians  of  the  carboniferous  age,  than  for  the  res- 
piration of  human  beings. 

I  regret,  as  much  as  any  one  can,  the  occasion  and  the 
necessity  that  exist  for  the  utterance  of  such  observations 
as  I  have  made.  We  of  the  medical  profession  will,  no 
doubt,  profit  pecuniarily  by  the  continuance  of  the  state  of 
things  which  I  have  described.  But  it  is  our  duty  to  view 
these  things  just  as  they  are,  and  whether  it  be  agreeable  or 
not,  to  tell  the  people  of  this  town  what  must  be  the  con- 
sequence of  a  further  neglect  of  some  general  and  efficient 
sanitary  regulations.  It  is  high  time  that  a  thorough  system 
of  drainage  and  sewerage  was  adopted  which  will  carry 
away  the  refuse  of  our  city,  and  render  the  air  about  us  in- 
capable of  contamination  from  such  a  source.  It  is  high 
time,  too,  that  measures  were  taken  to  prevent  the  accumu- 
lation of  culm  in  the  vicinity  of  our  city,  and  especially 
within  its  boundaries.  The  present  system  of  its  disposal 
is  a  shameful  waste.  The  world  needs,  and  at  no  distant 
day  will  need  still  more,  every  pound  of  that  material  which 
is  now  made  to  subserve  no  better  purpose  than  to  poison 
our  atmosphere  and  destroy  our  health. 

I  have  thus  passed  in  rapid  review  what  seem  the  most 
apparent,  tangible,  and  obvious  sources  of  malarial  diseases 
which  exist  in  this  locality.  .We  have  seen  that  some  of 
these  gases,  which  are  always  abundant  in  our  atmosphere, 
are  directly  destructive  to  the  tissues  of  the  body,  as  well  as 
to  the  corpuscles  of  the  blood.  Their  presence  in  the 
atmosphere,  therefore,  in  any  proportion,  must  necessarily 
render  it  more  or  less  unfit  for  respiration.  The  effects  of 
its  inhalation  must  in  all  cases  be  damaging — varying  in 
degree,  not  in  kind,  between  the  mildest  and  the  severest 
consequences  that  it  is  capable  of  producing.  All  agree 
that  there  is  a  general  prevalence  of  some  atmospheric  influ- 
ence in  this  vicinity  which  depresses  vitality  and  engenders 
disease.  During  the  entire  year — whether  it  be  wet  or  dry, 
hot  or  cold — there  is  a  general  and  a  constant  complaint  of 
"malaria!'    The  "  epizootic  "  in  its  day,  or  the  "  Tyler  gripe," 


15 

was  not  more  universal  in  its  sway  than  is  this  prevailing 
influence  which  everybody  feels  or  fancies,  and  designates 
"  malaria."  I  have  no  doubt  that  this  term  has  often  been 
used  indiscriminately  to  designate  ills  which  have  but  little 
connection  with  atmospheric  influence.  It  has  become 
with  us  a  fashion,  or  a  habit,  to  attribute  every  ill-feeling 
to  this  rather  indefinite  source.  Intemperance,  gluttony, 
exposure,  dissipation  and  excesses  of  every  kind  produce 
everywhere  a  prolific  brood  of  physical  and  mental  ills, 
from  which  our  population  is  by  no  means  exempt.  All 
these  are  usually  called  by  anything  but  their  proper  name, 
and  find  a  convenient  receptacle  in  this  general  but  rather 
indefinite  term — this  general  diagnostic  dumping  ground — 
"malaria.'" 

There  is,  however,  a  numerous  class  of  diseases  prevail- 
ing in  our  vicinity  which  doubtless  have  their  sources  in  the 
atmospheric  poisons  of  which  I  have  spoken.  It  is  quite 
uncommon  to  meet  with  a  resident  of  this  city  who  will  tell 
you  that  he  feels  thoroughly  and  uniformly  well.  He  will 
usually  tell  you  that  he  feels  an  unwonted  degree  of  oppres- 
sion or  of  languor;  that  he  has  backache,  headache,  neural- 
gia, nervous  irritability,  capricious  appetite,  impaired  diges- 
tion; that  he  is  peculiarly  sensitive  to  cold,  or  that  he  has 
slight  chills ;  in  short,  that  he  has  "the  malaria^  and  that 
he  has  been  taking  quinine.  He  will  also  tell  you  that  he 
always  feels  better  when  away  from  home;  that  even  a  short 
residence  elsewhere  always  improves  his  condition,  and  that 
the  beneficial  effects  of  even  a  few  hours'  respiration  of  the 
pure  air  of  our  mountains  are  plainly  and  unmistakably  felt 
by  him;  but  that  his  former  symptoms  are  again  gradually 
but  surely  developed  by  a  return  to  this  locality.  Are  the 
symptoms  so  generally  felt  and  complained  of  in  our  vicinity, 
which  I  have  here  enumerated,  as  well  as  the  more  severe 
forms  of  our  endemic  diseases,  produced  by  the  same  agents 
or  poisons  which  produce  the  malarial  diseases  of  other 
localities  ?  Or,  are  they  engendered  by  the  adulteration  of 
our  atmosphere  with  the  noxious  gases  which  are  produced 


i6 

by  the  peculiar  conditions  which  surround  us?  Do  the 
endemic  diseases  of  our  locality,  usually  termed  "malarial," 
differ  essentially  in  their  sources,  in  their  symptoms,  in 
respect  to  the  remedial  agents  best  adapted  to  their  cure, 
from  the  malarial  diseases  of  other  regions?  I  believe  that 
in  most  respects,  and  in  by  far  the  largest  number  of  in- 
stances, they  do.  My  reasons  for  this  belief,  briefly  stated, 
are  these: 

ist.  Miasmatic  fevers  usually  prevail  only  in  summer 
and  autumn.  A  freezing  temperature  generally  puts  an  end 
to  them.  Our  malarial  diseases  occur  at  all  seasons;  indeed, 
we  are  never  exempt  from  them.  They  are  often  most  prev- 
alent in  cold  weather,  toward  the  end  of  winter  or  in  early 
spring — the  very  seasons  when  ordinary  marsh  miasm  must 
necessarily  be  most  inactive. 

2d.  Diseases  produced  by  marsh  miasmata  are  usually 
strictly  periodical  in  their  occurrence,  except  in  their  more 
severe  forms — and  even  then  they  often  evince  a  tendency 
to  periodicity — that  is,  miasmatic  diseases  (as  generally 
seen)  present  intervals  of  comparative  health,  followed  by  a 
regular  succession  of  chills,  fever  and  sweating,  with  an  in- 
definite recurrence  of  the  same  symptoms  on  successive  or 
alternate  days.  Such  recurrence  is  seldom  seen  in  this 
locality;  a  complete  subsidence  of  the  fever  usually  termin- 
ates the  attack. 

jd.  The  disturbances  induced  by  our  malaria,  in  the 
milder  class  of  cases,  speedily  disappear  without  medication 
when  the  person  affected  is  removed  to  a  pure  atmosphere. 
This  change  takes  place  much  more  slowly  when  sickness 
is  induced  by  marsh  miasmata. 

4th.  The  ordinary  causes  which  produce  marsh  miasm 
exist  to  only  a  very  limited  extent  in  this  vicinity.  Most  of 
those  moist,  low  places  where  miasm  may  once  have  been 
evolved  are  now  covered  by  burning  culm  piles,  or  flooded 
by  mine  water,  in  either  case  effectually  preventing  the 
growth  of  cryptogamic  or  other  vegetation,  thus  prevent- 
ing the  production  of  ordinary  marsh  miasm. 


17 

jt/i.  The  symptoms  presented  by  our  endemic  diseases, 
while  differing  in  the  respects  just  stated  from  ordinary 
miasmatic  disease,  are  such  as  usually  result  from  the  inha- 
lation of  the  gases  evolved  by  the  combustion  of  coal. 

6th.  The  particular  periods  when  the  manifestations  of 
our  endemic  diseases  are  most  marked,  are  during  damp, 
still,  foggy  weather,  when  these  gases  accumulate  in  large 
quantity  and  in  concentrated  form.  The  periods  when  we 
are  most  exempt  from  them  are  during  and  immediately 
succeeding  brisk  winds — by  which  these  gases  are  speedily 
dissipated  or  carried  away. 

ytli.  There  are  still  some  marshy  grounds  within  the 
boundaries  of  our  valley,  which  have  not  yet  been  flooded 
with  mine  water,  nor  covered  with  culm,  where  marsh 
miasm  is  probably  generated,  and  where  that  class  of  dis- 
eases, which  is  always  produced  by  it,  may  yet  prevail;  but 
the  area  of  such  territory  is  so  limited  that  its  effects  can 
scarcely  be  general. 

I  have  no  doubt  that  cases  of  miasmatic  fever,  or  fever 
and  ague,  as  well  as  its  more  intense  forms,  occur  in  this 
city.  I  believe  I  occasionally  see  such.  I  see  many  cases 
which  I  can  trace  to  a  different  source — which  have  had 
their  origin  in  carbonic  and  sulphurous  gases — to  the  treat- 
ment of  which  quinine  seems  well  adapted.  But  this  is  by 
no  means  conclusive  proof,  nor  the  slightest  evidence,  that 
the  two  diseases  have  a  common  origin  or  a  common  char- 
acter. Both  these  malarial  influences  are,  apparently,  some- 
times combined  in  their  production. 

In  the  more  thickly  populated  portions  of  the  valley,  but 
especially  in  the  city  of  Wilkes-Barre,  endemic  diseases, 
while  deriving  their  principal  causes  and  acquiring  their 
chief  characteristics  from  the  gases  of  coal,  are  yet  greatly 
modified  or  intensified  by  the  commingling  of  other  poisons 
— both  gaseous  and  liquid — with  these.  The  vile  odors 
that  assail  our  olfactories  in  nearly  every  portion  of  the 
city,  emanating  from  filthy  streets,  from  stagnant  gutters, 
and  from  festering  pools,  greatly  intensify  and  often  strangely 


iS 

complicate  the  symptoms  of  these  diseases.  A  prolific 
brood  of  fatal  maladies  may  be  engendered  by  these  causes 
alone.  These  filthy  exhalations  certainly  contaminate  our 
atmosphere  in  a  manner  and  to  a  degree  that  is  alike  dis- 
gusting, dangerous,  and  disgraceful,  and  no  doubt  often 
make  it  exceedingly  difficult  to#determine  just  what  is  the 
remote  or  the  proximate  cause  of  a  particular  case  of  disease. 

In  most  cities,  and  I  believe  to  some  extent  in  our  own, 
the  gases  that  are  generated  in  sewers  sometimes  become  a 
means  of  vitiating  the  atmosphere  and  a  consequent  source 
of  disease.  The  evolution  of  gases  in  sewers  is  probably 
an  unavoidable  incident  with  all  systems  of  sewerage. 
These  are  exceedingly  complex  in  their  composition,  owing 
to  the  great  variety  of  decomposable  substances  which  find 
their  way  into  the  sewers  of  a  large  town.  The  most  noxious 
of  these  effluvia,  however,  and  those  which  most  extensively 
and  most  injuriously  affect  health,  are  sulphureted  hydro- 
gen and  sulphide  of  ammonium.  The  latter,  like  the  more 
damaging  gases  evolved  by  the  conbustion  of  coal,  is  pro- 
duced in  the  absence  of,  or  in  the  presence  of,  only  a  very 
small  quantity  of  oxygen.  The  few  sewers  which  we  have 
— I  mean  those  constructed  for  public  use — being  of  large 
size,  and  admitting  a  large  amount  of  atmospheric  air,  do 
not  engender  the  most  offensive  nor  the  most  dangerous 
gases  that  may  be  produced  in  sewers.  Still,  imperfect 
plumbing  and  carelessness  and  unskillfulness  in  building, 
often,  I  apprehend — certainly  sometimes — lead  to  the  com- 
plete permeation  of  dwellings  by  the  gases  from  sewers, 
with  more  or  less  injurious  effects  upon  those  who  respire 
them.  A  careful  and  thorough  supervision  should  be  exer- 
cised by  our  city  authorities  over  the  construction  of  all 
dwellings,  and  every  precaution  that  prudence  can  devise 
should  be  enforced  in  guarding  against  the  possible  produc- 
tion of  disease  from  such  sources. 

The  very  limited  extent  to  which  sewers  of  any  kind  have 
been  constructed  in  Wilkes-Barre  renders  it  improbable  that 
the  air  of  our  city  is  appreciably  affected  by  sewer  gases,  except 


19 

in  the  immediate  vicinity  of  the  sewers.  There  is  a  good 
reason,  however,  for  believing  that  some  of  the  small,  close, 
and  unventilated  private  sewers  about  our  city,  have  been, 
and  are  still,  a  frequent  source  of  disease.  I  understand 
that  a  very  severe  case  of  malarial  disease  has  recently 
occurred  in  the  family  of  one  of  our  members  which  was 
clearly  traceable  to  this  cause.  How  many  other  cases  of 
disease  and  of  death  in  our  city,  originating  in  a  similar 
source,  have  been  unjustly  charged  upon  Divine  Providence, 
we  can  only  conjecture. 

The  same  damaging  effects  upon  health  which  are  so  ex- 
tensively caused  by  the  burning  of  culm,  are  often  produced 
on  a  more  limited  scale,  but  with  even  greater  intensity, 
by  neglected  or  imperfect  appliances  for  the  warming  of 
dwellings,  or  in  the  use  of  coal  for  other  domestic  purposes. 
Instances  of  suffocation  and  of  death  from  these  causes  oc- 
casionally occur.  Cases  of  pneumonia,  of  bronchitis,  of 
neuralgia,  of  chills  and  fever,  originating  in  this  manner, 
and  of  greater  or  less  gravity,  are,  I  believe,  far  more  numer- 
ous than  is  generally  supposed,  not  only  in  this  vicinity 
but  wherever  anthracite  coal  is  consumed  as  fuel.  The  fre- 
quent complaints  of  malarial  diseases  that  are  heard  in  many 
of  the  larger  towns  and  cities  of  our  country,  where  marsh 
misam  is  certainly  not  prevalent,  but  where  anthracite  coal 
is  extensively  used,  are  probably  to  a  great  extent  due  to 
the  same  carbonic  and  sulphurous  gases  that  so  seriously 
impair  the  healthfulness  of  this  region. 

In  many  portions  of  Wyoming  Valley  the  springs  and 
wells  which  formerly  supplied  the  inhabitants  with  an  abun- 
dant supply  of  pure  and  wholesome  water,  have  been  ren- 
dered dry  by  the  operations  of  mining,  and  the  inhabitants 
have  consequently  been  compelled  to  obtain  their  water 
supply  from  adjacent  streams,  or  from  reservoirs  supplied 
by  pumping  water  from  the  Susquehanna  river.  The  city 
of  Wilkes-Barre  receives  a  partial  supply  of  tolerably  pure 
water,  during  the  greater  portion  of  the  year,  from  one  of 
the  mountain  streams.     Plymouth  obtains  a  much  smaller 


20 

and  less  adequate  supply  from  a  similar  source.  With 
these  exceptions,  the  water  which  the  inhabitants  of  this 
valley  use,  is,  as  a  rule,  exceedingly  impure  and  unwhole- 
some. 

Wherever  mining  operations  are  carried  on,  springs  and 
wells  in  that  vicinity  are  effectually  drained,  and  the  mineral 
tinctured  water  of  the  mines  is  poured  into  the  adjacent 
water  courses.  These  streams,  often  running  through  a 
densely  populated  neighborhood,  generally  become  the  re- 
ceptacles of  whatever  is  foul,  disagreeable  and  unwholesome, 
and  carry  their  impurities  into  the  Susquehanna.  To  what 
extent  these  streams  have  furnished  a  direct  water  supply  to 
our  population  I  am  unable  to  say;  but  the  inhabitants  of 
some  of  our  larger  towns  have  consumed  these  impurities  in 
by  no  means  homoeopathic  doses.  The  populous  town  of 
Pittston  derives  its  water  supply  from  the  Susquehanna  at  a 
short  distance  below  the  point  where  the  Lackawanna 
river  pours  into  it  a  current  of  water  so  foul  and  poisonous 
that  no  living  creature — not  a  fish,  not  even  a  reptile,  can 
exist  in  it.  Wilkes-Barre,  during  the  hottest  and  driest  por- 
tion of  the  year,  is  compelled  to  obtain  a  large  proportion  of 
the  water  it  consumes  from  a  similar  source.  Plymouth,  in 
addition  to  the  richness  imparted  to  the  water  of  the  Susque- 
hanna by  Mill  Creek,  Toby's  and  other  tributary  streams  of 
impurity,  has  the  benefit  of  whatever  filth  is  emptied  into 
the  former  river  by  the  sewers  of  Wilkes-Barre,  and  which 
is  not  retained  along  our  city  front  for  the  purposes  of  per- 
fuming our  own  atmosphere.  Just  what  that  substance  is 
that  by  courtesy  is  called  "water,"  in  the  vicinity  of  Nanti- 
coke,  I  am  not  able  to  state;  but,  judging  from  the  cadaver- 
ous looks  of  most  of  the  inhabitants  of  that  place,  I  should 
incline  to  the  opinion  that  it  is  not  very  largely  adulterated 
with  aqaa  pura. 

With  two  of  the  elements  so  essential  to  human  existence 
as  air  and  water  thus  rendered  impure  and  unwholesome, 
and  made  the  media  for  conveying  into  our  systems  the  agents 
and  the  germs  of  disease,  it  is  by  no  means  surprising  that 
suclijan  amount  of  "indigenous  malarial  disease'    has    for 


21 

years  prevailed  about  us  as  to  have  given  to  our  valley 
the  reputation  of  being  an  excellent  place  to  migrate  from; 
nor  is  it  to  be  wondered  at  that  its  physicians  should  all 
have  attained  the  reputation  of  being  practitioners  of  large 
experience. 

In  regard  to  the  medical  treatment  of  diseases  which  are 
the   consequences  of  the  atmospheric  conditions  which  I 
have  described,  I  am  unable  to  lay  down  any  general,  much 
less  any  specific,  rules.     In  the  milder  class  of  cases,  simple 
removal  to  a  pure  atmophere  is  all  that  is  required.     To 
those  who  must  remain  and  continue  to  inhale  the  poisons 
from  which  they  are  already  suffering,  tonics  and  stimulants 
usually    afford    at    least    an    alleviation  of  the  symptoms. 
Quinine,  especially,  seems  to  afford  a  ready  method  of  alle- 
viating discomfort  for  a  time,  but  in  the  more  severe  cases 
of  coal-gas  poisoning,  it  seems  altogether  incapable  of  effect- 
ing a  cure.    The  chills  and  fever,  with  their  concomitant 
symptoms,  run  on,  sometimes  to  a  fatal  termination,  in  spite 
of  the  usual  anti-periodic  remedies.     In  these  severe  forms 
of  our  endemic  diseases,  in  view  of  the  altered  or  deoxy- 
dized  condition  of  the  blood  corpuscles  known  to  be  pro- 
duced by  carbonic  oxide,  I  have  been  accustomed  to  admin- 
ister chlorate  of  potassa  in  conjunction  with  muriated  tinc- 
ture of  iron  and  quinine.     This  treatment,  upon  theoretical 
grounds  at  least,  would  seem  to  furnish  the   most  practical 
method  for  counteracting  the  poisonous  effects  of  the  gas, 
by  restoring  the  integrity  of  the  blood  corpuscles  and  sus- 
taining the  vigor  of  the  nervous  system.  These  are  important 
indications  to  be  fulfilled  in  all  cases  of  pure,  uncomplicated 
fever.     But,  as  I  have  already  stated,  our  endemic  diseases 
are  the  results  of  such  complex  causes,  and  present  such  a 
variety  of  symptoms,  that  no  specific  rules  can  be  adopted 
for  their  management.     Each  case  must  be  investigated  by 
itself,  and  treated  according  to  the  characteristics  which  it 
presents  and  the  lesions  which  exist,  by  whatever  methods 
most  commend  themselves  to  the  intelligence,   the  judg- 
ment, and  the  experience  of  the  physician  to  whose  care  it 
is  consigned. 


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